Scenario:

74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact.
Mild to moderate dysarthria. Able to protect airway.

In your Case Study Analysis related to the scenario provided, explain the following:

  • Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
  • Any racial/ethnic variables that may impact physiological functioning.
  • How these processes interact to affect the patient.

Solution Preview

Case Study Analysis- 74-year-old male

Introduction

In the case, a 74-year-old male with a history of smoking and hypertension was having dinner with his wife when he finds issues with speaking and later being unable to stand. On calling 911 and the EMS arriving he is taken to ED where it is found that he has a blood pressure of 178/94 and his has was unable to resist gravity. The identified motor problems show that he is not able to carry out somebody’s movements as desired. This report helps in the identification of neurological and musculoskeletal pathophysiological processes and ensuring that he is provided with the proper treatment. 

Neurological and musculoskeletal pathophysiologic processes

Vásquez-Correa et al. (2018) depict that dysarthria is a motor speech disorder that occurs as a result of the injury of the motor component of the motor speech system. The condition leads to the person being unable to articulate phonemes. The 74-year-old male patient is unable to speak and is drooling from the left side of his mouth. Concerning the musculoskeletal, the condition leads to the influence of the muscles of the tongue, lips, and the upper part of the respiratory system….

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